3701-14-01
Definitions and DRG reporting requirements.

(2)
"DRG" or "DRGs" means the
diagnosis-related group or groups that a hospital assigns based upon the
clinical record of the patient for the purpose of classifying inpatient
hospital services and determining reimbursement for services performed.

(3)
"Charge outlier case" means a
patient discharged from the hospital whose total charges are equal to or
greater than the charge trim point for that patient's DRG.

(4)
"Charge trim point" means two standard
deviations above the arithmetic mean of charges for all cases in a DRG.

(5)
"Day outlier case" means a
patient discharged from the hospital whose total number of inpatient days are
equal to or greater than the length of stay trim point for that patient's DRG.

(6)
"DRG refinement system" means
the severity of illness classification system developed by the "Health Systems
Management Group, School of Management, Yale University," as updated by the
director of health.

(7)
"HSMG
refinement grouper" means of the software which implements the DRG refinement
system, as updated by the director of health for discharges on or after October
first of each year.

(8)
"Hospital"
means an institution classified and registered as a hospital under section
3701.07 of the Revised Code.

(9)
"ICD-9-CM procedure code"
means an identifier assigned to describe the medical procedure used for the
treatment of illness and injury.

(10)
"Length of stay trim point" means two
standard deviations above the arithmetic mean of the length of stay for all
cases in a DRG.

(11)
"LOS" or
"length of stay" means the number of days a patient is in the hospital per
admission as calculated by counting the number of days from and including the
day of admission up to but not including the day of discharge.

(12)
"Mean" means the arithmetic average that
is calculated by adding the values and dividing by the number of cases.

(13)
"Median" means the middle
case where fifty per cent of the cases have lower values and fifty per cent of
the cases have higher values.

(14)
"Outpatient procedure" means a non-urgent medical procedure performed on an
outpatient basis in a hospital under the supervision of a physician for the
diagnosis or treatment of a disease or other disorder. "Outpatient procedure"
does not include procedures performed in clinics or other settings where only
ancillary services are provided or where physician services are not typically
provided, such as radiology, laboratory services, physical rehabilitation,
renal dialysis, or pharmacy.

(16)
"Refinement class" means the severity
level within each ADRG, as defined by the DRG refinement system and HSMG
refinement grouper, in which a patient may be classified based on the extent
that a patient's illness involves multiple complications and comorbid
conditions requiring a certain degree of complexity in treatment and diagnosis.

(17)
"Refinement group number" or
"RGN" means the complete four-digit number assigned by the HSMG refinement
grouper which consists of the ADRG code number in character positions one
through three and the refinement class code number in character position four.

(19)
"Primary procedure code" means the code
that identifies the principal procedure performed during the period covered by
a bill and the date on which the principal procedure described on the bill was
performed.

(B)
On or
before the first day of May each year, every hospital shall disclose to the
director of health the following inpatient data:

(1)
The total number of patients in each of
the sixty DRGs most frequently treated on an inpatient basis in the hospital as
represented by discharges during the previous calendar year and based upon the
DRG grouper in effect on the first day of October of the calendar year
preceding the calendar year which the patient was discharged. If DRG 468, 469,
or 470 appears on the list of most frequently treated DRGs, the DRG or DRGs
shall be removed from the list and the next most frequently treated DRG or DRGs
shall be substituted in its place:

(i)
Emergency room: For the
purposes of this provision, "admissions from emergency room" means the number
of patients admitted to the hospital through the emergency room upon the
recommendation of a physician;

(iii)
Other sources of admission
including, but not limited to, skilled nursing facilities or health care
facilities other than an acute care hospital; referrals from a personal
physician, clinic physician, health maintenance organization, a court of law; a
newborn if the patient was born in the facility; and those admissions for which
information is not available;

(e)
The number of cases, mean charges, and
mean length of stay in each refinement class or refinement group number
excluding all charge outlier cases and day outlier cases based on the trim
points provided and published by the director at least one hundred twenty days
prior to May first each year; and

(2)
The number of patients falling within DRG
numbers 468, 469, and 470.

Paragraphs (B)(1)(a) to (B)(1)(d) of this rule do not require
the disclosure of data for any DRG for which the hospital treated fewer than
ten patients during the year. Paragraph (B)(1)(e) of this rule does not require
the disclosure of data for any refinement group number for which the hospital
treated less than three patients during the year.

(C)
On or before the first day of May each
year, every hospital shall disclose to the director of health the following
outpatient data:

(1)
The total number of
patients in each of the sixty most frequently performed outpatient primary
procedures in the hospital as reported by ICD-9-CM primary procedure codes for
patients treated during the previous calendar year.

(2)
The mean and median of the total hospital
charges for those sixty most frequently performed outpatient procedures
identified in paragraph (C)(1) of this rule.

(3)
The hospital is not required to disclose
data for any procedure for which the hospital treated fewer than ten patients
during the year.

(1)
Submit the hospital
identification and certification form, prescribed in appendix A of this rule,
signed by the chief executive officer of the hospital;

(2)
Submit the inpatient data required to be
reported under this rule to the director in an electronic format as provided in
appendix B of this rule, or in a paper format as provided in appendix C to this
rule, and report the DRG data required by paragraph (B)(1) of this rule in
descending order according to the frequency of admissions with the DRG having
the most frequent number of admissions reported first;

(3)
Submit the outpatient data required to be
reported under this rule to the director in an electronic format as provided in
appendix D to this rule and report the procedure data required by paragraph (C)
of this rule in descending order according to the frequency of patients with
the procedure having the most frequent number of patients reported first.

(E)
Each hospital may
include with the data disclosed under this rule commentary concerning reasons
for major deviations in the range of data for any DRG. The hospital shall
submit the commentary in the format prescribed by appendix C to this rule. Any
release of the data disclosed under this rule identifying a hospital shall
include the commentary, if any, submitted by the hospital pursuant to this
paragraph.

(F)
Any releases by the
department of information collected pursuant to section
3727.34 of the Revised Code that
list charge data by hospital shall include conspicuous language explaining that
the data in the report either has been reported by severity of illness or
adjusted with respect to the severity of illness of the patients and that an
individual hospital's average charges may differ significantly from the average
charges of a group of hospitals because of a variety of reasons including, but
not limited to:

(G)
Under no circumstances shall the name or
social security number of a patient, dentist or physician be submitted under
this rule.

Appendix A

Hospital Identification

Annual Hospital Data Disclosure Most Frequently Treated DRGs

Report Period: January 1, 20_____ - December 21, 20_____

This disclosure of data for inpatient discharges is required to
be completed by all Ohio hospitals in accordance with section
3727.34 of the Ohio Revised
Code, and rule 3701-14-01 of the Administrative Code.

I hereby certify that the information disclosed in accordance
with section 3727.34 of the Ohio Revised Code
and rule 3701-14-01 of the Administrative Code is true to the best of my
knowledge.

Sworn to me and subscribed to in my presence, this
_______________ day of _________________________________, 20______.

APPENDIX B

Description of Inpatient Data File Requirements

ELECTRONIC VERSION

This electronic file includes all of the numerical data
required for reporting. It is in ASCII format, with one record per DRG
reported, in a fixed length 215 character record. A carriage return is imbedded
at the end of each record.

The file will be labeled with the Hospital's ODH registration
number in the first four characters of the MS-DOS filename followed by a
period, followed by "DAT". Example: 1100.DAT

FIELD IDENTIFICATION CHARACTER POSITIONS DECIMAL PLACES FIELD
TYPE JUSTIFICATION SPECIAL INSTRUCTIONS

Hospital Numbers 1-4 A Left ODH Hospital ID number

DRG Number 5-7 A Left DRGs are reported in rank order from 1-60
with the DRG having the most number of patient admissions ranked first. If
there are DRGs with an equal number of discharges, they are reported with the
DRG having the highest average charge reported first. If DRG 468, 469 or 470
appears on the list of most frequently treated DRGs, the DRG or DRGs shall be
removed from the list and next most frequently treated DRG or DRGs shall be
added. DRGs for which the hospital treated fewer than 10 patients in the
calendar year are not required to be reported.

N. of Discharges 11-15 N Right

Mean Charge 16-21 N Right

Median Charge 22-27 N Right

Lowest Charge 28-33 N Right

Highest Charge 34-40 N Right

Mean Los 41-46 2 N Right Decimal points are imbedded.

Median Los 47-52 1 N Right Decimal points are imbedded.

Lowest Los 53-55 N Right

Highest Los 56-59 N Right

N. of Emergency Admissions 60-64 N Right

N. of Hospital Transfers 65-69 N Right

Other Admissions 70-74 N Right

Comment Indicator 75 A Place an asterisk "*" in this field if
comments will be included in the comment file for this DRG.

Severity of Illness Classification Levels Patients who are
either charge or day outliers should not be included in severity data reported
below. If the number of patients in any refined group number (RGN) is less than
3, information on charges and length of stay is not required for the RGN. There
may be up to 7 RGN's for each DRG.

Refinement Group Number Number of Discharges Mean Charges Mean
Length of Stay

1

2

3

4

5

6

7

1 Hospital may attach any commentary concerning reasons for
major deviations in the range of data for any DRG.

Appendix D

Outpatient Data File Requirements

The file must be in ASCII format. The file includes one record
per procedure reported in a fixed length 32 character record. A carriage return
is imbedded at the end of each record.

The file must be labeled with the hospital's ODH registration
number in the first four, followed a period, and followed by "out". Example:
1100.out

Field Identification Character Position Field Type
Justification Special Instructions

ODH Hospital Registration Number 1-4 A Left

Procedure Number 5-9 A Left

Rank Order 10-11 A Left Procedures are reported in rank order
from 1-60 with the procedure having the most number of visits ranked first. If
there are procedures with equal number of cases, they are reported with the
procedure having the highest mean charge reported first. Procedures for which
the hospital treated less than 10 patients in the calendar year are not
required to be reported.

Number of Patients 12-17 N Right

Mean Charge 18-24 N Right No decimal. Round to the nearest
whole number

Median Charge 25-31 N Right No decimal. Round to the nearest
whole number

Comment Indicator 32 A Left Place an Asterisk "*" in this field
if comments will be included in the comment file.